Longer-term increased cortisol levels in young people with mental health problems

Higher prenatal anxiety predicts lower neonatal hair cortisol

BACKGROUND

Prenatal glucocorticoids are one of the most widely proposed prenatal programming mechanisms, yet few studies exist that measure fetal cortisol via neonatal hair. Neonatal hair provides a window into the fetal experience and represents cortisol accumulation in the third trimester of pregnancy. In the current study, we test the links between two types of anxiety over the course of gestation (pregnancy-related anxiety and general anxiety) with neonatal hair cortisol.

METHOD

Pregnant individuals (N = 107) and their neonates (59.8% female) participated in the current study. Prenatal pregnancy-related anxiety and general anxiety were measured using the Pregnancy Related Anxiety Scale (PRAS) and the State-Trait Anxiety Inventory (STAI), in each trimester of pregnancy. Hierarchical linear modeling was used to model the intercept and slope of each type of anxiety over gestation. Neonatal hair samples were collected shortly after birth (Median days = 1.17, IQR = 0.75-2.00).

RESULTS

Both higher pregnancy-related anxiety and general anxiety at the beginning of pregnancy and a flatter decline of pregnancy-related anxiety over gestation were associated with lower neonatal hair cortisol. After inclusion of gestational age at birth and parity as covariates, pregnancy-related anxiety (intercept: β = -0.614, p =.012; slope: β = -0.681, p =.006), but not general anxiety (intercept: β = -0.389, p =.114; slope: β = -0.302, p =.217) remained a significant predictor. Further, when both general and pregnancy-related anxiety were entered into the same model, only pregnancy-related anxiety (intercept and slope) were significant predictors of neonatal hair cortisol, indicating an association with pregnancy-related anxiety above and beyond general anxiety.

CONCLUSION

Cortisol plays a central role in maturation of fetal organ systems, and at the end of gestation, higher cortisol has beneficial effects such as promoting fetal lung maturation. Further, lower maternal cortisol is linked to less optimal cognitive development and altered brain development. As maternal higher anxiety in early pregnancy and a flatter decrease over time are both associated with lower neonatal hair cortisol, maternal pregnancy-related anxiety could be a target of future intervention efforts.

A Chemical Structure and Machine Learning Approach to Assess the Potential Bioactivity of Endogenous Metabolites and Their Association with Early Childhood Systemic Inflammation

Metabolomics has gained much attention due to its potential to reveal molecular disease mechanisms and present viable biomarkers. This work uses a panel of untargeted serum metabolomes from 602 children from the COPSAC2010 mother-child cohort. The annotated part of the metabolome consists of 517 chemical compounds curated using automated procedures. We created a filtering method for the quantified metabolites using predicted quantitative structure-bioactivity relationships for the Tox21 database on nuclear receptors and stress response in cell lines. The metabolites measured in the children's serums are predicted to affect specific targeted models, known for their significance in inflammation, immune function, and health outcomes. The targets from Tox21 have been used as targets with quantitative structure-activity relationships (QSARs). They were trained for ~7000 structures, saved as models, and then applied to the annotated metabolites to predict their potential bioactivities. The models were selected based on strict accuracy criteria surpassing random effects. After application, 52 metabolites showed potential bioactivity based on structural similarity with known active compounds from the Tox21 set. The filtered compounds were subsequently used and weighted by their bioactive potential to show an association with early childhood hs-CRP levels at six months in a linear model supporting a physiological adverse effect on systemic low-grade inflammation.

The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence

Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise highrisk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, largescale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders.

A chemical structure and machine learning approach to assess the potential bioactivity of endogenous metabolites and their association with early-childhood hs-CRP levels

Metabolomics has gained much attraction due to its potential to reveal molecular disease mechanisms and present viable biomarkers. In this work we used a panel of untargeted serum metabolomes in 602 childhood patients of the COPSAC2010 mother-child cohort. The annotated part of the metabolome consists of 493 chemical compounds curated using automated procedures. Using predicted quantitative-structure-bioactivity relationships for the Tox21 database on nuclear receptors and stress response in cell lines, we created a filtering method for the vast number of quantified metabolites. The metabolites measured in children's serums used here have predicted potential against the chosen target modelled targets. The targets from Tox21 have been used with quantitative structure-activity relationships (QSARs) and were trained for ~7000 structures, saved as models, and then applied to 493 metabolites to predict their potential bioactivities. The models were selected based on strict accuracy criteria surpassing random effects. After application, 52 metabolites showed potential bioactivity based on structural similarity with known active compounds from the Tox21 set. The filtered compounds were subsequently used and weighted by their bioactive potential to show an association with early childhood hs-CRP levels at six months in a linear model supporting a physiological adverse effect on systemic low-grade inflammation. The significant metabolites were reported.

Neurobiological risk factors for problematic social media use as a specific form of Internet addiction: A narrative review

Problematic social media use (PSMU) is a behavioral addiction, a specific form of problematic Internet use associated with the uncontrolled use of social networks. It is typical mostly for modern adolescents and young adults, which are the first generations fully grown up in the era of total digitalization of society. The modern biopsychosocial model of the formation of behavioral addictions, postulating the impact of a large number of biological, psychological, and social factors on addictive behavior formation, may be quite applicable to PSMU. In this narrative review, we discussed neurobiological risk factors for Internet addiction with a focus on current evidence on the association between PSMU and structural/ functional characteristics of the brain and autonomic nervous system, neurochemical correlations, and genetic features. A review of the literature shows that the vast majority of the mentioned neurobiological studies were focused on computer games addiction and generalized Internet addiction (without taking into account the consumed content). Even though a certain number of neuroimaging studies have been conducted for PSMU, there is practically no research on neuropeptide and genetic associations for PSMU to date. This fact points to the extremely high relevance of such studies.

A systems biology approach for discovering the cellular and molecular aspects of psychogenic non-epileptic seizure

Objectives

Psychogenic non-epileptic seizure (PNES) is the most common non-epileptic disorder in patients referring to epilepsy centers. Contrary to common beliefs about the disease's harmlessness, the death rate of PNES patients is similar to drug-resistant epilepsy. Meanwhile, the molecular pathomechanism of PNES is unknown with very limited related research. Thus, the aim of this in silico study was to find different proteins and hormones associated with PNES via a systems biology approach.

Methods

Different bioinformatics databases and literature review were used to find proteins associated with PNES. The protein-hormone interaction network of PNES was constructed to discover its most influential compartments. The pathways associated with PNES pathomechanism were found by enrichment analysis of the identified proteins. Besides, the relationship between PNES-related molecules and psychiatric diseases was discovered, and the brain regions that could express altered levels of blood proteins were discovered.

Results

Eight genes and three hormones were found associated with PNES through the review process. Proopiomelanocortin (POMC), neuropeptide Y (NPY), cortisol, norepinephrine, and brain-derived neurotrophic factor (BDNF) were identified to have a high impact on the disease pathogenesis network. Moreover, activation of Janus kinase-signaling transducer and activator of transcription (JAK-STAT) and JAK, as well as signaling of growth hormone receptor, phosphatidylinositol 3-kinase /protein kinase B (PI3K/AKT), and neurotrophin were found associated with PNES molecular mechanism. Several psychiatric diseases such as depression, schizophrenia, and alcohol-related disorders were shown to be associated with PNES predominantly through signaling molecules.

Significance

This study was the first to gather the biochemicals associated with PNES. Multiple components and pathways and several psychiatric diseases associated with PNES, and some brain regions that could be altered during PNES were suggested, which should be confirmed in further studies. Altogether, these findings could be used in future molecular research on PNES patients.

General practitioners' everyday clinical decision-making on psychosocial problems of children and youth in the Netherlands

BACKGROUND

Psychosocial problems in children and youth are common and may negatively impact their lives and the lives of their families. Since general practitioners (GPs) play a crucial role in detecting and intervening in such problems, it is clinically necessary to improve our insight into their clinical decision-making (CDM). The objective of this study was to explore which mechanisms underlie GPs' everyday CDM and their options for management or referral.

MATERIAL AND METHODS

This was a mixed methods study in which qualitative (interview substudy) and quantitative (online survey substudy) data were collected from GPs. Using a question framework and vignettes representative of clinical practice, GPs' CDM was explored. GPs were selected by means of an academic research network and purposive sampling. Data collection continued in constant comparison between both substudies. Using grounded theory, data from both substudies were triangulated into a flowchart consisting of mechanisms and management/referral options.

RESULTS

CDM-mechanisms were divided into three groups. GP-related mechanisms were GPs' primary approach of the problem (somatically or psychosocially) and their self-assessed competence to solve the problem based on interest in and knowledge about youth mental health care. Mechanisms related to the child and its social context included GPs' assessment whether there was psychiatric (co)morbidity, their sense of self-limitedness of the problem and assessed complexity of the problem. Whether GPs' had existing collaboration agreements with youth care providers and how they experienced their collaboration were collaboration-related mechanisms.

CONCLUSION

The current study contributes to a relatively unexplored research area by revealing GP's in-depth thought processes regarding their CDM. However, existing research in this area supports the identified CDM mechanisms. Future initiatives should focus on validating CDM mechanisms in a larger population. If confirmed, mechanisms could be integrated into GP training and may offer guidelines for regulating proper access to mental health care services.

Can dogs serve as stress mediators to decrease salivary cortisol levels in a population of liberal arts college undergraduate students?

The steroid hormone cortisol can be used to measure physiological stress in humans. The hypothalamic-pituitary-adrenal (HPA) axis synthesizes cortisol, and a negative feedback cycle regulates cortisol depending on an individual's stress level and/or circadian rhythm. Chronic stress of college undergraduate students is associated with various adverse health effects, including anxiety and depression. Reports suggest that stress levels have risen dramatically in recent years, particularly among university students dealing with intense academic loads in addition to COVID-19 pandemic-related uncertainty. The increasing rate of mental illness on college campuses necessitates the study of mediators potentially capable of lowering stress, and thus cortisol levels. Research on mediation techniques and coping mechanisms have gained traction to address the concerning levels of stress, including the employment of human-animal interaction sessions on college campuses. In this study, human-canine interaction as a stress mediation strategy for undergraduate students was investigated. We measured salivary cortisol levels in 73 college undergraduate students during a 60-min interaction period with a dog to determine whether human-canine interactions are effective in lowering cortisol levels and potentially reducing chronic stress typical of undergraduate students. Our results indicate that a human-canine interaction for 60 min is an effective method for significantly reducing salivary cortisol and stress levels among undergraduate college students. These findings support the expansion of animal visitation programs on college campuses to help students manage stress.

Do subjective and objective measures of stress agree in a clinical sample of youth and their parents?

This study explored agreement and potential relationships among perceived stress (self-reported using the Perceived Stress Scale), hair cortisol concentration (HCC), and mental disorders in a clinical sample of youth and their parents. Data were collected from a cross-sectional sample of 48 youth (38 females; mean age = 15.6 years) with a mental disorder and 72 parents (65 females; mean age = 45.49 years). Agreement was assessed using Bland-Altman plots and intraclass correlation coefficients. Multiple regression was used to model the association between covariates and HCC and perceived stress for youth and parents. Agreement between perceived stress and HCC was low for both youth and parents (ICC = 0.15 to 0.31). Among youth, lower income (β = 0.24) and parent psychopathology (β = 0.42) were associated with higher HCC. Female sex (β = 0.42) and higher parent psychopathology (β = 0.28) were associated with higher perceived stress, whereas chronic physical illness was associated with lower perceived stress (β = −0.24). Among parents, female sex (β = −0.21) was associated with lower HCC and family functioning (β = 0.46) was associated with higher perceived stress. In youth, higher HCC was associated with generalized anxiety (OR = 1.14) and higher perceived stress was associated with major depressive episode (OR = 1.33), generalized anxiety (OR = 1.10), and separation anxiety (OR = 1.14). Among parents, higher HCC was associated with depression (β = 0.27) and perceived stress was associated with depression (β = 0.53) and anxiety (β = 0.45). This exploratory study shows that agreement between psychological and physiological stress is low in a clinical sample of youth and their parents. Sociodemographic and psychosocial factors, and mental health, are differentially associated with psychological and physiological stress.

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Agreement between perceived stress and hair cortisol is low for youth and parents.

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Sex, physical illness, and parent psychopathology are associated with youth stress.

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Sex and family functioning are associated with stress among parents.

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Hair cortisol and perceived stress are differentially associated with mental illness.

The Interplay Between Stress and Immunity Triggers Herpes Zoster Infection in COVID-19 Patients: A Review

Coronavirus disease 2019 (COVID-19) is a potential health threat in the highly mobile society of the world. Also, there are concerns regarding the co-infections occurring in COVID-19 patients. Herpes zoster (HZ) is now being reported as a co-infection in COVID-19 patients. It is a varicella-zoster virus induced viral infection affecting older people and immunocompromised individuals. Reactivation of HZ infection in COVID-19 patients are emerging and the mechanism of reactivation is still unknown. A most convincing argument would be, increased psychological and immunological stress leading to HZ in COVID-19 patients, and this review justifies this argument.

Examining longitudinal associations between self-reported depression, anxiety and stress symptoms and hair cortisol among mothers of young children

BACKGROUND

Maternal mental health is critically important given its impacts on both women's and children's outcomes. Hair cortisol concentrations (HCC) may provide insight into physiological processes underpinning mental health. This study investigated associations between mothers' self-reported mental health symptoms and their HCC at 1, 2 and 3 years postpartum.

METHODS

Longitudinal study of Australian mothers recruited for their experience of adversity in pregnancy ('right@home' trial, N=722). Mental health symptoms were self-reported using the Depression, Anxiety and Stress Scales (DASS). Associations between DASS total and subscale scores and HCC were estimated using linear regression and generalized estimating equation (GEE) models, examining associations: at each age; across all ages (multivariate GEE); and with persistence of high symptom severity. Missing data were addressed using multiple imputation.

RESULTS

546/722 (76%) women provided at least one hair sample (71% at 1, 61% at 2, 49% at 3 years). Associations between DASS total or subscale scores and HCC were not evident across time points. Only dichotomized high depression symptom severity was associated with higher HCC in the GEE models (β=0.12, p=0.04). There was no evidence of associations between persistence of high DASS symptom severity and HCC at 3 years.

LIMITATIONS

The DASS measured self-reported symptoms for the preceding week whereas HCC captured average cortisol over three months. Associations amongst mothers experiencing adversity may not represent patterns in the general population.

CONCLUSIONS

Considered in context with existing literature, these findings suggest that HCC provides limited insight into the mental health of mothers experiencing adversity across the early postpartum years.

HPA-axis activity and the moderating effect of self-esteem in the context of intimate partner violence in Cameroon

BACKGROUND

The experience of intimate partner violence (IPV) is stressful. One objective way to monitor it is to assess victims' stress response by measuring the concentration of their salivary cortisol, the major stress hormone released by the hypothalamic-pituitary-adrenal axis.

OBJECTIVE

We investigated how the IPV experienced by women in Cameroon affects their stress levels and those of their children.

METHOD

We recruited 50 mother-child dyads exposed to IPV and a control group of 25 mother-child dyads. All mothers completed questionnaires, including the Revised Conflict Tactics Scale to assess IPV, the Sense of Coherence Scale, and the Self-Esteem Scale, to assess their psychological resources. Mothers were asked to collect 3 saliva samples from themselves and 3 from their children on a single weekday: immediately after waking up, 30 minutes after waking up, and 45 minutes after waking up. The total cortisol secretion over the first hour after awakening was determined by calculating the area under the curve with respect to the ground (AUCg).

RESULTS

Mothers exposed to IPV exhibited higher total post-awakening cortisol concentrations compared with those in the control group. However, no significant difference was found between exposed and non-exposed children. In addition, higher IPV, specifically injuries, was significantly and positively associated with greater AUCg among mothers exhibiting lower self-esteem. When self-esteem was high, however, no significant effect of IPV on AUCg was observed.

CONCLUSIONS

Of particular clinical significance is that self-esteem can modulate the stress levels of women exposed to IPV, a valuable insight into the development of effective psychosocial interventions to support IPV victims in sub-Saharan Africa.

Prevalence of Depression and Psychological Distress and Perturbations of Cortisol Dynamics in Attendants of Hospitalized Patients: An Observational Pilot Study

Background: Attendants of in-hospital patients are prone to undue stress resulting in depression, anxiety, melancholy and psychological distress. Hitherto available studies cater to attendants of patients admitted in critical care units and none have ventured to look into their cortisol dynamics. Herein, we have evaluated the magnitude of psychological distress and depression amongst ostensibly healthy attendants of non-critically ill patients and correlated them with cortisol dynamics. 

Methods: Non-critically ill patients admitted to the general medicine ward were chosen by purposive sampling and one attendant was selected from each patient. Those with known risk factors, psychiatric illnesses, chronic drug intake, addictions, and overweight/obesity were excluded. Psychological distress and depression were assessed using the General Health Questionnaire 12-items (GHQ-12) and the Patient Health Questionnaire (PHQ-9), respectively. Morning plasma cortisol, late-night plasma cortisol (LNPC), late-night salivary cortisol (LNSC), urinary free cortisol (UFC), and plasma cortisol after overnight 1 mg dexamethasone administration were measured. 

Results: After exclusion, 39 participants were recruited (M:F=2.3:1.6). The mean age was 34.1±11.4 years. The mean duration of stay in hospital ambience prior to recruitment was 16.2±1.2 days. Based on the PHQ-9 score, 55% of the participants had depression. Psychological distress prevailed in 13% of participants as per the GHQ-12 score. The median LNPC/LNSC was higher in participants with depression compared to those with no depression, however, there was no statistically significant difference. There was no significant correlation between GHQ-12/PHQ-9 scores and cortisol dynamics. 

Conclusions: Although depression is prevalent in about half of the patient attendants, cortisol dynamics remain largely unaltered over a short period of two to three weeks.

Biosensor and Lab-on-a-chip Biomarker-identifying Technologies for Oral and Periodontal Diseases

Periodontitis is a complex multifactorial disease that can lead to destruction of tooth supporting tissues and subsequent tooth loss. The most recent global burden of disease studies highlight that severe periodontitis is one of the most prevalent chronic inflammatory conditions affecting humans. Periodontitis risk is attributed to genetics, host-microbiome and environmental factors. Empirical diagnostic and prognostic systems have yet to be validated in the field of periodontics. Early diagnosis and intervention prevents periodontitis progression in most patients. Increased susceptibility and suboptimal control of modifiable risk factors can result in poor response to therapy, and relapse. The chronic immune-inflammatory response to microbial biofilms at the tooth or dental implant surface is associated with systemic conditions such as cardiovascular disease, diabetes or gastrointestinal diseases. Oral fluid-based biomarkers have demonstrated easy accessibility and potential as diagnostics for oral and systemic diseases, including the identification of SARS-CoV-2 in saliva. Advances in biotechnology have led to innovations in lab-on-a-chip and biosensors to interface with oral-based biomarker assessment. This review highlights new developments in oral biomarker discovery and their validation for clinical application to advance precision oral medicine through improved diagnosis, prognosis and patient stratification. Their potential to improve clinical outcomes of periodontitis and associated chronic conditions will benefit the dental and overall public health.

Association of dietary acid-base load and psychological disorders among Iranian women: A cross-sectional study

Metabolic acidosis, which can be affected by dietary acid-base load, seems to be associated with psychological disorders through different pathways. Given limited evidence on dietary acid-base load, we aimed to examine the association of dietary acid-base load with psychological disorders in Iranian women. This cross-sectional study was performed on 447 female subjects (20-50 years old). Dietary intake was assessed using a valid food frequency questionnaire for Iran. Dietary acid-base load was calculated through different indices including potential renal acid load (PRAL), net endogenous acid production (NEAP), and dietary acid load (DAL). To assess psychological disorders, an Iranian validated version of depression, anxiety, and stress scale (DASS-21) was used. The mean value of PRAL, NEAP, and DAL were -8.87mEq/da, 37.94mEq/day, and 30.77mEq/day, respectively. Considering a wide range of confounding variables, compared with the first tertile, a significant positive association was observed between dietary acid-base load and depression (OR_PRAL: 3.63; 95 %CI:1.97, 6.71; P_trend = 0.0001) (OR_NEAP:3.42; 95 %CI: 1.87, 6.23; P_trend = 0.0001) (OR_DAL: 3.02; 95 %CI: 1.64, 5.58; P_trend = 0.0001). Women in the high dietary acid-base load category had higher anxiety (OR_PRAL: 3.31; 95 %CI: 1.81, 6.06; P_trend = 0.0001) (OR_NEAP:3.47; 95 %CI: 1.90, 6.33; P_trend = 0.0001) (OR_DAL: 3.25; 95 %CI: 1.76, 5.98; P_trend = 0.0001). Moreover, there was a strong positive relationship between dietary acid-base load and psychologicaldistress (OR_PRAL: 3.79; 95 %CI: 2.09, 6.90; P_trend = 0.0001) (OR_NEAP: 3.67; 95 %CI: 2.04, 6.58; P_trend = 0.0001) (OR_DAL: 3.00; 95 %CI: 1.66, 5.43; P_trend = 0.0001). Women with higher dietary acid-base load score had greater odds for depression, anxiety, and psychological distress compared to lower ones.

Individual resting-state frontocingular functional connectivity predicts the intermittent theta burst stimulation response to stress in healthy female volunteers

Intermittent theta burst stimulation (iTBS) delivered to the dorsolateral prefrontal cortex (DLPFC) has been investigated as a promising treatment for stress and stress‐related mental disorders such as major depression, yet large individual differences in responsiveness demand further exploration and optimization of its effectiveness. Clinical research suggests that resting‐state functional connectivity (rsFC) between the DLPFC and the anterior cingulate cortex (ACC) can predict iTBS treatment response in depression. The present study aimed to investigate whether rsFC between the left DLPFC and ACC subregions could predict the degree to which the stress system is affected by iTBS. After assessment of baseline resting‐state fMRI data, 34 healthy female participants performed the Trier Social Stress Test on two separate days, each followed by active or sham iTBS over the left DLPFC. To evaluate iTBS effects on the stress‐system, salivary cortisol was measured throughout the procedure. Our results showed that a stronger negative correlation between the left DLPFC and the caudal ACC was linked to a larger attenuation of stress‐system sensitivity during active, but not during sham iTBS. In conclusion, based on individual rsFC between left DLPFC and caudal ACC, iTBS could be optimized to more effectively attenuate deregulation of the stress system.

Exercise-Based Interventions for Internet Addiction: Neurobiological and Neuropsychological Evidence

With the increase in the number of internet users, the problems associated with excessive internet use have become increasingly obvious. Internet addiction can alter neurobiology, and its symptoms can be alleviated through exercise, but whether exercise exerts these effects through neurobiological pathways is unclear. Here, we reviewed the neurobiological mechanisms of exercise-based interventions against internet addiction by searching PubMed and Google Scholar for relevant research using such keywords as “exercise”, “internet addiction”, “hypothalamic-pituitary-adrenal axis”, “neurotrophin”, and “dopamine”. This review summarizes advances in our understanding of the neurobiological processes through which exercise can reduce internet addiction, and our analysis strengthens the idea that exercise-based interventions can be effective in this regard. The available evidence suggests that exercise can increase the levels of neurotrophic factors, cortisol, and neurotransmitters; improve the morphology of specific parts of the central nervous system, such as by stimulating hippocampal neurogenesis; protect the autonomic nervous system; and control the reward urge. In other words, exercise appears to mitigate internet addiction by regulating the neurobiology of the central and autonomic nervous systems. In this way, exercise-based interventions can be recommended for reducing internet addiction.

Psychological and Sociodemographic Variables related to Cortisol in Hair in Spanish Healthy Population

Some recent researches have shown the important role of hair cortisol as a retrospective biomarker of chronic stress. The aim of this research was to investigate the relationship between hair cortisol levels and sociodemographic and psychological variables, such as perceived stress levels and psychopathological symptoms on a Spanish population. The sample consisted of 347 healthy people, 230 women and 117 men, with an average age of 33.39 years (SD = 12.63). Hair cortisol levels were measured by obtaining a hair sample. In addition, a psychological assessment composed by: Analogic-Visual Stress Scale, Perceived Stress Scale (PSS), Symptom Checklist 90 Revised (SCL-90-R) and the assessment of vital stressful events suffered, was carried out. The mean cortisol level was 108.93 pg/mg (SD = 66.43) in men, and 120.38 pg/mg (SD = 87.26) in women. The linear hierarchical regression showed that Analogic-Visual Stress Scale and perceived stress levels were related with higher hair cortisol levels (R2 = .032; t = 2.21; p = .029). Due to the relationship between daily stress levels, Analogic-Visual Stress Scale, anxiety sub-scale of SCL 90-R and perceived stress levels with hair cortisol levels, we conclude that there is a relation between perceived yourself stressed and the physiological levels.

Cumulative cortisol exposure increases during the academic term: Links to performance-related and social-evaluative stressors

OBJECTIVE

To examine whether cumulative cortisol production changes during a period of increased demands when cortisol and stress are assessed concurrently. The study also compared stress perceptions vs. cumulative stressful events on their respective association with cortisol output. Finally, it explored whether certain types of stressful events, those involving school/job performance or social-evaluative threat, were linked to cortisol levels across multiple weeks.

METHOD

The current study assessed cumulative cortisol production via hair sample in 56 undergraduates (88 % female) during both lower stress (summer break) and higher stress (academic term) periods. During the latter, both negative events (checklist) and stress perceptions were assessed weekly, and these reports were aggregated across the 10-weeks to minimize retrospective bias.

RESULTS

Cortisol levels in hair samples were significantly higher (d = 0.84) during the academic term (M = 14.24 pg/mg, SD = 11.36) compared to summer break (M = 8.00 pg/mg, SD = 4.14), suggesting greater cumulative exposure to cortisol. Although perceived stress was not associated with cortisol levels (r_partial(53) = .10, p = 0.46), exposure to more stressful events (r_partial(53) = .27, p = 0.047), particularly events involving academic demands (r_partial(53) = .37, p = 0.006), or negative evaluation/social rejection (r_partial(53) = .27, p = 0.045), was positively associated with cumulative cortisol exposure.

CONCLUSIONS

This study demonstrates that cortisol levels in hair may be linked to cumulative exposure to stressors when measured concurrently (3 months), and that stressful events, rather than perceptions, are reflected in HPA axis activity. Real-world stressors involving performance demands and social-evaluative threat accumulate to enhance cortisol production, consistent with their acute HPA effects in the lab. Hair samples may provide a window into the past by allowing researchers to feasibly assess cortisol production before, during, and after the onset of a chronic stressor.

Individual differences in glucocorticoid regulation: Does it relate to disease risk and resilience?

Glucocorticoid (GC) signaling varies among individuals, and this variation may relate to individual differences in health outcomes. To determine if and which aspects of signaling (basal, circadian, integrative, or reactivity) are associated with specific health outcomes, we reviewed recent studies that relate GCs to health outcomes. We identified papers through PubMed and reviewed 100 original research articles related to mental health, cardiovascular health, cancer, diabetes, obesity, pulmonary health, sleep, and fitness. Many studies reported elevated GC secretion associated with worse health, but this was only particularly true for integrative GC measures. On the other hand, accentuated cortisol awakening response and a steeper circadian rhythm were both associated with positive health outcomes. Overall, relationships between GC secretion and health outcomes were relatively weak. This systematic review of relationships between GC metrics and health outcomes highlights the importance of careful consideration when selecting methods to measure GC regulation in health research.

Cortisol Responses to Naturally Occurring Psychosocial Stressors Across the Psychosis Spectrum: A Systematic Review and Meta-Analysis

BACKGROUND

Individuals with established psychosis and those at high-risk for the disorder have been found to show abnormalities within the hypothalamic-pituitary-adrenal (HPA) axis, including elevations in basal and diurnal cortisol, but a blunted cortisol awakening response. However, the extent to which these features are associated with psychosocial stressors encountered in the natural environment (which are known to be more commonly experienced by these groups, and more distressing) is currently unclear. We therefore conducted a systematic review and meta-analysis to investigate the concordance between naturally-occurring psychosocial stressors and cortisol levels in these populations.

METHODS

PubMed, PsycINFO, and EMBASE were searched up to November 2019 to identify studies examining the concordance between psychosocial stressors and cortisol in healthy controls and individuals on the psychosis spectrum (patients with established psychosis and/or high-risk individuals). An overall meta-analysis (including data for all stressor-cortisol pairings) was performed to determine the degree of concordance irrespective of group status, with meta-regression employed to test whether the degree of concordance differed in established psychosis and high-risk groups compared to controls. Planned stratified analyses were then performed to examine group differences (where established psychosis and high-risk groups were combined) within individual stressor-cortisol pairings.

RESULTS

Eighteen studies (16 datasets) were eligible for inclusion. The overall model, comprising 134 effect sizes, showed that stressors and cortisol measures were only weakly correlated [r=0.05 (95% CI: -0.00 to 0.10), p=0.059] and that neither established psychosis status (r=0.01, p=0.838) nor high-risk status (r=0.02, p=0.477) had a significant effect of the strength of correlation. In stratified analyses, significant differences between healthy controls and psychosis spectrum groups were observed for only one of the six stressor-cortisol pairings examined, where life event exposure and diurnal cortisol were positively correlated in controls [r=0.25 (95% CI: 0.01 to 0.46)], but negatively correlated in the psychosis spectrum group [r=-0.28 (95% CI: -0.49 to -0.04)].

CONCLUSIONS

Overall, we observed poor concordance between naturally-occurring psychosocial stressors and cortisol irrespective of stressor type, cortisol measure, or group status. We consider a range of methodological factors that may have obscured the ability to detect "true" associations and provide recommendations for future studies in this field.

A systematic review of studies utilizing hair glucocorticoids as a measure of stress suggests the marker is more appropriate for quantifying short-term stressors

Quantitating glucocorticoids (GCs) in hairs is a popular method for assessing chronic stress in studies of humans and animals alike. The cause-and-effect relationship between stress and elevated GC levels in hairs, sampled weeks later, is however hard to prove. This systematic review evaluated the evidence supporting hair glucocorticoids (hGCs) as a biomarker of stress. Only a relatively small number of controlled studies employing hGC analyses have been published, and the quality of the evidence is compromised by unchecked sources of bias. Subjects exposed to stress mostly demonstrate elevated levels of hGCs, and these concentrations correlate significantly with GC concentrations in serum, saliva and feces. This supports hGCs as a biomarker of stress, but the dataset provided no evidence that hGCs are a marker of stress outside of the immediate past. Only in cases where the stressor persisted at the time of hair sampling could a clear link between stress and hGCs be established.

The association between adversity and hair cortisol levels in humans: A meta-analysis

Adverse life events are associated with a constellation of negative health outcomes. Theory and research suggest that the hypothalamic-pituitary-adrenal (HPA) axis acts as one mechanism connecting adverse experiences with negative health outcomes. However, this relation is complicated by the potential for adversity to be associated with both hyperactivity and hypoactivity of the HPA axis, as assessed in both animal and human studies. Over the past decade, methodological advances have enabled the sampling of cortisol stored in hair, which provides a marker of HPA axis activity over a several-month period. The present meta-analysis included 28 studies to assess the strength and direction of the relation between adverse experiences and hair cortisol levels. Analyses were conducted using multilevel modeling (MLM) to quantify the magnitude of effects and mixture modeling to identify distinct subgroups of studies. Results of MLM analyses indicated that the overall effect size was small but significant d = 0.213, 95% CI [0.034, 0.397]. There was also significant between-study variance (τ = 0.155, 95% CI [0.065, 0.367]). Mixture modeling to identify distinct classes of studies based on effect size and direction resulted in a 2-class model: The first class included four studies with an overall negative and moderate effect size (d = -0.478, 95% CI [-0.639, -0.318]), and the second class included the remaining 24 studies with an overall positive and significant, albeit small, effect size (d = 0.141, 95% CI [0.084, 0.199]). Moderator analyses indicated that the strength and direction of the association between adversity and hair cortisol were moderated by features of the adversity exposure (e.g., type of adversity, timing of adversity), characteristics of the samples (e.g., clinical status, racial distribution), and features of the publication (e.g., publication type, geographic region of study). The findings refine our understanding of the long-term impact of adversity on dysregulation of the HPA axis, particularly as reflected in hair cortisol measures.

DNA methylation and sex-specific expression of FKBP5 as correlates of one-month bedtime cortisol levels in healthy individuals

Chronic exposure to cortisol is associated with cardiovascular, metabolic, and psychiatric disorders. Although cortisol can be readily measured from peripheral sources such as blood, urine, or saliva, multiple samplings spanning several days to weeks are necessary to reliably assess chronic cortisol exposure levels (referred to as cortisol load). Although cortisol levels in hair have been proposed as a measure of cortisol load, measurement is cumbersome and many people are not candidates due to short hair length and use of hair dyes. To date, there are no blood biomarkers that capture cortisol load. To identify a blood biomarker capable of integrating one-month cortisol exposure levels, 75 healthy participants provided 30+ days of awakening and bedtime saliva cortisol and completed psychosocial measures of anxiety, depression, and stress. Mean daily awakening and bedtime cortisol levels were then compared to CpG methylation levels, gene expression, and genotypes of the stress response gene FKBP5 obtained from blood drawn on the last day of the study. We found a correlation between FKBP5 methylation levels and mean 30+day awakening and bedtime cortisol levels (|r|≥0.32, p ≤ 0.006). We also observed a sex-specific correlation between bedtime cortisol levels and FKBP5 mRNA expression in female participants (r = 0.42, p = 0.005). Dividing the 30-day sampling period into four weekly bins showed that the correlations for both methylation and expression were not being driven by cortisol levels in the week preceding the blood draw. We also identified a female-specific association between FKBP5 mRNA expression and scores on the Beck Anxiety Inventory (r = 0.37, p = 0.013) and Beck Depression Inventory-II (r = 0.32, p = 0.033). Finally, DNA was genotyped at four SNPs, and variation in rs4713902 was shown to have an effect on FKBP5 expression under a codominant model (f = 3.41, p = 0.048) for females only. Our results suggest that blood FKBP5 DNA methylation and mRNA expression levels may be a useful marker for determining general or sex-specific 30-day cortisol load and justifies genome-wide approaches that can potentially identify additional cortisol markers with broader clinical utility.

Hair Cortisol in Twins: Heritability and Genetic Overlap with Psychological Variables and Stress-System Genes

Hair cortisol concentration (HCC) is a promising measure of long-term hypothalamus-pituitary-adrenal (HPA) axis activity. Previous research has suggested an association between HCC and psychological variables, and initial studies of inter-individual variance in HCC have implicated genetic factors. However, whether HCC and psychological variables share genetic risk factors remains unclear. The aims of the present twin study were to: (i) assess the heritability of HCC; (ii) estimate the phenotypic and genetic correlation between HPA axis activity and the psychological variables perceived stress, depressive symptoms, and neuroticism; using formal genetic twin models and molecular genetic methods, i.e. polygenic risk scores (PRS). HCC was measured in 671 adolescents and young adults. These included 115 monozygotic and 183 dizygotic twin-pairs. For 432 subjects PRS scores for plasma cortisol, major depression, and neuroticism were calculated using data from large genome wide association studies. The twin model revealed a heritability for HCC of 72%. No significant phenotypic or genetic correlation was found between HCC and the three psychological variables of interest. PRS did not explain variance in HCC. The present data suggest that HCC is highly heritable. However, the data do not support a strong biological link between HCC and any of the investigated psychological variables.

Stress vulnerability in male youth with Internet Gaming Disorder

Internet Gaming Disorder [IGD] was introduced as new behavioral addiction in DSM-5 Section 3. Vulnerability to stress is a potential predisposing factor for IGD. Given a lack of preexisting empirical data, the study investigated differences in the psychological and neurobiological response to acute stress in patients with IGD. 24 young men (mean age 18.38 years; range 13-25 years) fulfilling DSM-5 criteria for IGD and 25 matched controls underwent the Trier Social Stress Test [TSST]. Participants provided hair samples for the analysis of basal hypothalamic-pituitary-adrenal [HPA] axis activity and clinical interviews were conducted to assess psychopathology. During the experiment, participants reported on their subjective stress experience and momentary affect, provided samples of salivary cortisol and their heart rate was continuously recorded. Patients with IGD reported greater everyday and chronic stress, as well as psychopathological comorbidity. No differences were found on measures of hair cortisol. Compared to controls, IGD patients showed an attenuated cortisol response (χ²₍₇₎=25.75, p<0.001) and greater negative affect (χ²₍₇₎=17.25, p=0.016) in response to acute stress. Heart rate (χ²₍₁₎=5.49, p=0.019), negative affect (χ²₍₁₎=5.60, p=0.018) and subjective stress (χ²₍₁₎=5.55, p=0.019) were transiently increased in IGD patients. After adjusting for sportive activities, IGD patients showed transiently decreased cortisol (χ²₍₁₎=5.20, p=0.022), potentially indicating general HPA-axis dysfunction beyond altered reactivity. Stress reactivity showed correlations with IGD symptom severity. Findings illustrate differences in acute psychological and neurobiological stress reactivity in patients with IGD. Alterations of the stress response system may be involved in the development and maintenance of IGD.

Covariation between plasma phosphate and daytime cortisol in early Parkinson's disease

BACKGROUND

Disturbed phosphate homeostasis in early Parkinson's disease (PD) may originate from a stress-related condition and nutritional status among other risk factors, age, and gender.

METHODS

Risk of malnutrition using Mini-nutritional assessment (MNA score) and plasma levels of protein markers and daytime cortisol at the time of diagnosis in PD (n = 75) were compared with a control group (n = 24). Cognition was assessed using the Mini-Mental State Examination (MMSE score) and motor function using Unified Parkinson's Disease Rating Scale (UPDRS-part III scale).

RESULTS

The patients with PD had significantly lower MNA score than controls which correlated with plasma phosphate levels. The logistic regression revealed that increasing MNA protected from low plasma phosphate, final score (OR = 0.399; 95% CI = 0.196-0.816; p = .012) and total score (OR = 0.656; 95% CI = 0.422-1.018; p = .060). Phosphate correlated with albumin (r = .315; p < .006), transferrin (r = .331; p < .004) and cortisol (r = -0.355; p < .002) confirmed by logistic regressions. Increasing albumin protects from low phosphate after adjusting in logistic regression (OR = 0.806; 95% CI = 0.682-0.952; p = .011) and after including variables from Table 1 in backwards elimination, final step (OR = 0.800; 95% CI = 0.660-0.969; p = .022). MNA total score and cortisol correlated inversely, confirmed in logistic regression for MNA total score (OR = 0.786; 95% CI = 0.627-0.985; p = .037) and for MNA initial score (OR = 0.650; 95% CI = 0.453-0.930; p = .020).

CONCLUSION

This study highlights the importance of phosphate for optimal nutritional status by association with MNA score and albumin in plasma. An inverse relationship between phosphate and cortisol indicate, in addition, that low phosphate levels may affect cognition and motor function in PD.

Hair Cortisol and Its Association With Psychological Risk Factors for Psychiatric Disorders: A Pilot Study in Adolescent Twins

Measuring cortisol in hair is a promising method to assess long-term alterations of the biological stress response system, and hair cortisol concentrations (HCC) may be altered in psychiatric disorders and in subjects suffering from chronic stress. However, the pattern of associations between HCC, chronic stress and mental health require clarification. Our exploratory study: (1) assessed the association between HCC and perceived stress, symptoms of depression and neuroticism, and the trait extraversion (as a control variable); and (2) made use of the twin design to estimate the genetic and environmental covariance between the variables of interest. Hair samples from 109 (74 female) subjects (age range 12-21 years, mean 15.1) including 8 monozygotic (MZ) and 21 dizygotic (DZ) twin pairs were analyzed. Perceived stress was measured with the Perceived Stress Scale and/or the Daily Life and Stressors Scale, neuroticism, and extraversion with the NEO-Five Factor Inventory or the Junior Eysenck Personality Questionnaire, and depressive symptoms with the Somatic and Psychological Health Report. We found a modest positive association between HCC and the three risk factors - perceived stress, symptoms of depression, and neuroticism (r = 0.22-0.33) - but no correlation with extraversion (-0.06). A median split revealed that the associations between HCC and risk factors were stronger (0.47-0.60) in those subjects with HCC >11.36 pg/mg. Furthermore, our results suggest that the genetic effects underlying HCC are largely shared with those that influence perceived stress, depressive symptoms, and neuroticism. These results of our proof of principle study warrant replication in a bigger sample but raise the interesting question of the direction of causation between these variables.